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Deviated nasal septum causes, pathology, symptoms, treatment

Definition: It is displacement of the thin wall within the nose that separates the nasal cavity away from the midline. As septum deviation is very common (about 80%), the term "Deviated Septum" refers only to severely displaced nasal septums.

Etiology:

a. Developmental
It may be due to excessive development of one plate of vomer more than the other, excessive development of turbinate pushing septum or high arched palate.
Deviated-nasal-septum-causes-treatment
b. Traumatic
Intrauterine, birth trauma (common), or accidental.
Incidence: very common but usually not severe to cause symptoms.

Pathological variants:
  1. C shaped deviation.
  2. S shaped deviation.
  3. Spur: sharp angulation at the junction between cartilage and bone.
  4. Dislocation: lower border projects into nostril.

Symptoms of deviated septum:

  • Nasal obstruction unilateral or bilateral.
  • Epistaxis: Convex side vessels angulated. Concave side atrophic changes (dry friable mucosa).
    nasal-septum
  • Neuralgia & headache: Contact (anterior ethmoidal nerve compression). Vacuum (fronto-nasal duct obstruction).
  • Recurrent sinusitis.
  • External nasal deformity.

Signs of deviated septum:

  • Septal deviation, spur, or dislocation.
  • Compensatory turbinate hypertrophy.
Deviated-nasal-septum

Investigations:

  • Endoscopic examination.
  • CT, if sinusitis is suspected.
    CT-nose-deviated-septum
  • Rhinomanometry & acoustic rhinometry (objective tests).

Treatment of deviated septum: 

Surgical correction, indicated in symptomatic cases.
Operation
  1. Sub mucous resection (SMR)
  2. Septoplasty indicated when SMR is not useful: children, and septal dislocation.


NB: during surgery for septal correction: treat sinusitis if present by ESS, reduce size of inferior turbinate if large.

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